28 F.4th 1033
10th Cir.2022Background
- Wayne Bowker, a pretrial detainee with several chronic conditions (bipolar disorder, heart disease, thyroid issues, etc.), was jailed in Carter County and died on June 30, 2016.
- CCJ had no consistent licensed physician; Kimberlee Miller was the only staff with medical training (40 hrs/week) and often slow or unresponsive off-duty; deputies had minimal medical training.
- Bowker had multiple ER visits (May 18, June 5, June 11) with discharge orders for follow-up (neurology, psychiatry, primary care) and prescribed medications; after June 11 he received no follow-up and missed several medications.
- Jail policies (e.g., refusing medication unless in bubble packs; $100 transport fee) and staffing/training gaps delayed or denied continuity of care; CPAP brought by family was not accepted because of packaging rules.
- In the 19 days after June 11, Bowker deteriorated (fecal incontinence, catatonia, repeating incoherent phrases); Miller spoke with him June 29 but did not arrange emergency care and instead called the criminal judge; Bowker was found unresponsive June 30 and died of cardiomegaly.
- Procedural posture: district court granted summary judgment to Miller (qualified immunity) and to the Sheriff (official-capacity). The Tenth Circuit reversed both grants, holding facts create triable issues on deliberate indifference and municipal liability.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Miller violated Bowker’s constitutional rights by deliberate indifference to serious medical needs | Miller ignored obvious signs of psychosis, catatonia, incontinence and failed to provide/arrange medical care after ER discharges | Miller contends she did not deliberately disregard serious risk and that symptoms were attributable to bipolar disorder; she provided some ER referrals | Reversed district court: a reasonable jury could find Miller acted with deliberate indifference (objective and subjective prongs met) |
| Whether Miller is entitled to qualified immunity because the right was not clearly established | Prince: law clearly establishes duty to provide/arrange care for obvious serious needs; prior Tenth Circuit decisions provided fair warning | Miller: prior cases not sufficiently analogous; she did not completely deny care because Bowker had ER visits | Right was clearly established; qualified immunity denied on summary judgment because analogous Tenth Circuit authority put officials on notice |
| Whether Carter County (Sheriff in official capacity) is liable under Monell for training/staffing/medical-delivery failures | County maintained customs of inadequate training, understaffing, and delay that caused Bowker’s death; Sheriff knew of prior similar deaths | County argues absence of a single policymaker action and that individual immunity defeats municipal claims | Triable issues exist: reasonable jury could find customs/policies and deliberate indifference by County causing death; summary judgment improper |
| Whether CCJ’s failures causally produced Bowker’s death (sufficient evidence of causation) | Expert opined a reasonable probability that lack of continuous care and withheld meds caused death; prior similar deaths show pattern | County disputes causation and argues other medical factors (cardiomegaly) explained death | Jury question: causation dispute precludes summary judgment; plaintiff met burden to create genuine factual dispute |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (1976) (deliberate indifference to serious medical needs violates Eighth Amendment)
- Bell v. Wolfish, 441 U.S. 520 (1979) (pretrial detainees entitled to at least the same standard of medical care under Due Process)
- Sealock v. Colorado, 218 F.3d 1205 (10th Cir. 2000) (denial of hospital transport for chest pain could support deliberate indifference)
- Olsen v. Layton Hills Mall, 312 F.3d 1304 (10th Cir. 2002) (mental-health related panic attack may be sufficiently serious; denial of care may defeat qualified immunity)
- Al-Turki v. Robinson, 762 F.3d 1188 (10th Cir. 2014) (medical professional’s complete denial of care despite recognizable emergency can state a claim)
- McCowan v. Morales, 945 F.3d 1276 (10th Cir. 2019) (delay in providing medical care can amount to deliberate indifference; informs clearly established prong)
- Mata v. Saiz, 427 F.3d 745 (10th Cir. 2005) (deliberate indifference requires both objective seriousness and subjective knowledge)
- Martinez v. Beggs, 563 F.3d 1082 (10th Cir. 2009) (objective component: sufficiently serious medical need standard)
- Monell v. Department of Social Services, 436 U.S. 658 (1978) (municipal liability only when policy/custom causes constitutional violation)
- Bd. of County Comm’rs v. Brown, 520 U.S. 397 (1997) (municipal liability for failure to train requires deliberate indifference)
- Barney v. Pulsipher, 143 F.3d 1299 (10th Cir. 1998) (municipal deliberate indifference may be shown by actual or constructive notice and conscious disregard)
- Foelker v. Outagamie County, 394 F.3d 510 (7th Cir. 2005) (similar facts where hallucinations and fecal soiling supported denial-of-care claim)